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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :.............. .................. �:. _ Xgmpletoin Triplicate) • • •-•••-••__._._.--- r ...................... - � Permit No. 7-d�� ........................ this Permit Expires I Year From Date Issued Date Issued 3,.12=2.7 Application is hereby made to the'Son Joaquin Local Health District for a permit to construct and Install the work herein descri ed s ap I:catio is ma in compliance with County Ordinance No. 549 and existing Rules and Regulations: 10B �� S�r � SS/LOCATtbN N/._.__...__...._ !_.: %FE/(�j dva:..�l.:of...... �a� EAiS�l1S TRACT .................. Owner's Name ,. !lr1 , ivy P,a, �3�X /ate � mi�� jonl f¢([f ~3��u-........ _ Phone Address 2!f ! _ •95T' h' 'Y. �/�iP/��i�t�ti Tdr✓ .....City r, �� ra�f ---•--•• ..... .......... ................• . Contractor's Name -----•-•-__-- � ---.License �' .............. Phone --•••---•................... --- •--- ---------- Installation will serve: Residence©Apartment House Co mercial OTrailer Court 0' Motel [ Other--__Jret?_l_P!.....TZ? ._...r.a.rr'-6/r1 1 Number of living units:__..../---- Number of bedrooms .......2._Garbage' Grinder ........ Lot Size Water Supply: Public System and name ........................................................------------............................................Private Character of soil to a depth of 3 feat. Sand ] Siff�] Clay Peat 0 Sandy Loam �] Clay Loam [] i Hardpan 0 Adobe 0 Fill M6teriaf 'If yes,...---...... a............... ............ type �. (Plot plan, showing size of lot, focation of system In relation to wells; buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} k I PACKAGE TREATMENT E l SEPTIC TANK Size_......................... -------•••- •------- Liquid Depth ....'��. .............. Capacity �o�� _---.. Type U•%^e- g . Material.�dE7.CrC V --- No. Compartments .... .............. Distance to nearest: Well a ....Foundation jI.A. ._....._ Prop. Line ..... ............ LEACHING LINE No. of Lines _...-_----I-_--_----- Length of each line.._._.-QLI............. Total Length 'D' Box .....L... - � -- ............... { Type Filter Material Depth Filter ,Material ......../.9................ Distance to nearest: Well r ...... Foundation /.J------------- Property Eine ..__5... SEEPAGE PIT � De th - --- p ,�S --_-- fliameter ��3---___. Number ................./......... Rock Filled Yes t ,No Water Table Depth ..._.....-- r p �/!�Q_..,!-•------ --------flock Size _Sor_4.C_-- Rat-k Distance to nearest: Well ...__..._Sr1.0.._.---•--•_-. ..Foundation Prop, line ... •-•••-------. REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date ...:.,...................... Septic Tank (Specify Requirements) ....................... . Disposal Field (Specify Requirements) ----.................................................... ------••-------••- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Haeme owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, I shall not employ any person in such manner as to b ome subject to Workman's Compensation laws of California." Signed . . _ _I - - Owner By ----- ------• -- •............... -----•-- Title _...----.... of er.than owner) _. --�---- ._...-•-----••-------------- FO PA TMENT USE ONLY APPLICATION ACCEPTED BY ..._ .... -- DATE _-•--_ r BUILDING PERMIT ,1SSUI:D ........................ ... •--------•-•-------- DATE .... ADDITIONAL COMMENTS ---------------------- --------- ........................... - ------ ----------- ...:.............................I---------•- ----- ---------...__...._.-..... ................ - I --------------....................... Final Inspection by: ..._ IEH 13 2h 1-68 &ev. 5M ................................. ...._.._..-....._. ..._ . ...------ •-----Date . - ......� SAN ..._.. --•------ ....... JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M